The Supply Crisis in Transplantation

The predominant issue in transplantation biology is now one of increasing the supply of organs for patients in need of them. This is not only a technical problem, but in some cases, raises ethical issues as well. For instance, there have been cases of parents with a sick child purposely conceiving a second child for the main purpose of being a bone marrow donor for their ailing offspring. There has also been the rise of a black market in body parts, particularly emanating from China, in which various organs from executed prisoners are offered for sale.

Researchers have come up with numerous new options to improve on the availability of organs needed for transplantaion. For instance, chemicals can be used to stimulate a patient's own stem cells (cells that can develop into almost any type of tissue, depending upon the local influences it encounters) to migrate from the bone marrow to the diseased organ, develop into the right type of cell, and regenerate the organ. A more controversial application of stem cell research involves the use of embryonic stem cells. One version of this strategy is to remove DNA from the patient's own skin cells, inject it into a donated human egg from which the nucleus has been removed, and then allow that egg to develop into an early-stage embryo. The embryo can then be harvested for embronic stem cells that can be influenced into growing into the organ of choice. Another major strategy is to collect embryonic stem cells from aborted fetuses or from umbilical cord blood. This whole topic has become a very highly debated issue due to the involvement of human embryos, as has the entire burgeoning field of stem cell-applied medical treatment.

Transplantation

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Adapted from Roitt, 2001.

TYPES OF TRANSPLANTATION

Autograft

From one part of the body to another e.g. trunk to arm

Autograft

From one part of the body to another e.g. trunk to arm

Syngraft

Between genetically identical individuals e.g.

monozygotic twins, or within an inbred strain

Allograft

Between different members of the same species e.g. Mr. Smith to Mr. Jones

Xenograft

Between members of different species e.g. monkey to man

Another option is called tissue scaffolding. The strategy in this technique is to take the patient's cells (or cells from a donor) and inject them into a three-dimensional scaffold of biodegradable polymers that are in the shape of the desired organ. The entire structure is transplanted, and the cells in the scaffold replicate, reorganize, and form a new organ. Research indicates that cells are surprisingly adept at regenerating the tissue of their origin. As the cells grow, and the polymers of the scaffold naturally degrade, what is left is a new, functioning organ. The obvious problem with this technique, as with options using stem cells, is that it takes time to form the new organ. This is of little help to a patient who is in immediate need of a transplant.

One of the most promising, and controversial, sources for new organs for humans are xenotransplants from other species, particularly baboons and pigs. Many individuals are very strongly opposed to raising animals for the sole purpose of harvesting their organs for humans, viewing it as inhumane. Another area of controversy, particularly concerning baboon donors, is the possibility of spreading unknown diseases into the human population. There are already established precedents for viral diseases jumping from primates to humans, such as the AIDS virus (HIV), Ebola virus, and the hantavirus. Consequently, there is a fear that xenotransplantaion could unleash a new plague upon humans. More and more xenotransplant research is moving toward the use of pigs, since it is very much less likely that a pig virus could